1841385614 NPI number — DR. BHUVARAGHAMURTHY THANGAMANI M.D.

Table of content: DR. BHUVARAGHAMURTHY THANGAMANI M.D. (NPI 1841385614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841385614 NPI number — DR. BHUVARAGHAMURTHY THANGAMANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THANGAMANI
Provider First Name:
BHUVARAGHAMURTHY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THANGAMANI
Provider Other First Name:
BRIAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1841385614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 E WASHINGTON ST
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
IONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-527-8293
Provider Business Mailing Address Fax Number:
616-527-5718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
IONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-527-8293
Provider Business Practice Location Address Fax Number:
616-527-5718
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  BT039404 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02630 . This is a "PRIORITY HEALTH PAY TO ER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103176376 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104425037 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200000000909 . This is a "PHPMM HOSPITAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000004612 . This is a "PHPMM OFFICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3176376 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700C460070 . This is a "BCBS OFFICE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1003025 . This is a "MCLAREN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383218134 . This is a "TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 35937 . This is a "P HEALTH OFFICE PAY TO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700C460060 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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